CONTENT

What is angina
Causes of angina pectoris
Pathophysiology
Classification of angina pectoris
Clinical Manifestations
Medical Management and treatment
Nursing intervention & responsibility
 ANGINA PECTORIS

Is clinical syndrome characterized by pain in anterior chest(usually characterized

by
episodes or paroxysms of pain
or pressure in the anterior chest) produced as a result of insufficient coronary
blood flow & myocardial hypoxia
 Several factors are associated with typical anginal pain:
1. • Physical exertion, which can precipitate an attack by increasing myocardial
oxygen demand
2. • Exposure to cold, which can cause vasoconstriction and an elevated blood
pressure, with increased oxygen demand
3. • Eating a heavy meal, which increases the blood flow to the mesenteric area
for digestion
4. • Stress or any emotion-provoking situation, causing the release of
adrenaline and increasing blood pressure, which may accelerate the heart rate
and increase the myocardial workload
 Pathophysiology
Narrowing in the coronary artery , which results from plaque
accumulation in the intima lining
obstruction of blood flow , which diminish myocardial oxygen supply .
 Classification
1. Stable angina.
Also known as 'effort angina', this refers to the classic type of angina related
to myocardial ischemia. A typical presentation of stable angina is that of chest
discomfort and associated symptoms precipitated by some activity (running,
walking, etc.) with minimal or non-existent symptoms at rest or after
administration of sublingual nitroglycerin.[
 Classification

2. Unstable angina .
Unstable angina (UA) (also "crescendo angina"; this is a form of
acute coronary syndrome) is defined as angina pectoris that changes or
worsens .
 Unstable angina is different. The pain or
discomfort
1. • often happens when you are sleeping or resting
2. • takes you by surprise
3. • might last as long as 30 minutes and might become progressively worse
4. • cannot be relieved with rest or medication
5. • might be a sign of a heart attack that will happen soon
 Clinical Manifestations
1. pain or other symptoms, varying in severity from a
feeling of indigestion to a choking or heavy sensation in
the upper chest
2. The pain is often felt deep in the chest behind the upper
or middle third of the sternum (retrosternal area)
3. Typically, the pain or discomfort is poorly localized and
may radiate to the neck, jaw, shoulders, and inner
aspects of the upper arms, usually the left arm.
Associated symptoms
 Assessment and Diagnostic Findings
1. The diagnosis of angina is often made by evaluating the clinical manifestations of ischemia and
the patient’s history
2. A 12-lead ECG
3. blood laboratory
4. patient may undergo an exercise or pharmacologic stress test in which the heart is monitored by
ECG
5. Echocardiogram
6. cardiac catheterization and coronary artery angiography)
7. CAD is believed to result from inflammation of the arterial endothelium. C-reactive protein (CRP)
is a marker for inflammation of vascular endothelium.
 Medical Management
The objectives of the medical management of angina are to decrease the oxygen
demand of the myocardium and to increase the oxygen supply. intracoronary
stents, and atherectomy
CABG
Atherectomy
Percutaneous transluminal coronary angioplasty (PTCA)
 PHARMACOLOGIC
THERAPY
1. Nitroglycerin ( Angised).
2. beta-adrenergic blocking agents(Beta-blockers such as
propranolol(Inderal), metoprolol.
3. calcium channel blockers such as amlodipine , verapamil, and diltiazem.
4. Antiplatelet agents (Aspirin.) Clopidogrel (Plavix)and Heparin.
5. Oxygen Administration.
 Nursing intervention & responsibility
1. Diet
2. I.V therapy
3. oxygen therapy
4. monitor & record VS , I/O
5. advice patient to rest if pain is begin
6. obtain an ECG reading during & acute attack
7. keep the patient in semi- fowler’s position
 REFERENCES
Juan Carlos Kaski, Guy D. Eslick, C. Noel Bairey Merz · 2013 ·
 Institute of Medicine, Board on the Health of Select Populations, Committee on Social
Security Cardiovascular Disability Criteria · 2010
Majid Maleki, Azin Alizadehasl, Majid Haghjoo · 2017 ·
Alice P. Gallo, Margaret L. Jones · 2008
James T. Willerson, David R. Holmes, Jr. · 2015
Thank your
Audience